Another vote for Jerome Goldberg - he did my op. He also did Chris Webbs surgery too. I would see either him or Des Bokor (also in Sydney) - these are the top 2 guys in Australia apparently. One thing to watch with Jerome is that his rehab is very conservative and whilst his repairs are very strong, the slow return to movement can leave you with a lessened ROM. See the best person you can afford (Jerome charged me $2,500 iirc). There are plenty of guys that can patch up the average person to get on with their life but not that many that sportsmen trust (the guys above do loads cricketers, league players etc) to get back to full form. I had the surgery in June 2008 to fix a big SLAP lesion. In the end it was 4 anchors to lash it back down and an acromioplasty to fix an impingement. Its renowned as a painful procedure and in my experience this was certainly true. Many strong painkillers were consumed and sleepless nights suffered. 4 weeks in a sling without being allowed to straighten the arm followed by 6 months of pain, rehab and physio. Being in a sling and not being able to dress/wash yourself and struggling with minor things like wiping your arse is extremely frustrating. One thing you can be sure of is that your shoulder will never be quite the same again due to the surgical 'tightening' but you can adapt reasonably well. My ROM isn't great but apart from hard gastons on the mended side, I can pretty much do everything I could pre-surgery.

On surgery - don't go with someone just because they'll see soon. As a climber, you want the best. The person I generally suggest people go to is Greg Hoy at Melbourne Orthopaedic Group in Windsor.

A good friend of mine used to do his shoulder rehabs (physio) and recommended him highly. I saw him a while ago when I needed an opinion and happy to say he lived up to reputation. I managed to avoid surgery, thanks to some great physio and soft-tissue work, but if I hadn't been so lucky, he's the only one I would have trusted to work on me. He's a lovely person AND a great surgeon too. His client group includes a number of Australia's top athletes and is someone I'd be happy to send you to.

I'd also recommend you go see Wendy Braybon first, either Wendy or else get in touch with Julian (Saunders, osteo, now in the Blue Mountains).

Julian won't be able to examine you directly (unless you want to drive up there) but he will be able to review the scans and via skype I'm sure he'll be able to give you a good sense of the relationship between what the imaging shows and where you want to go as a climber. He'll also be able to look at your range of motion etc remotely via webcam and should be able to give you a pretty good assessment based on that plus history etc. It'll cost you, but surgery is a pretty high price to pay for injury and with surgery you'll pay in terms of scaring, pain, down-time etc etc, as well as financially.

One thing to consider is that surgery may not be your only option. Again, this is where you need to get advice from a range of people, including osteopaths and physios. The idea is to get you fully functional and pain free again, physically cutting you open and repairing the lesion **may** not be the only way to achieve that outcome. The lesion itself won't heal without surgery, but, depending on the situation you may be able to strengthen / retrain other structures in the rotator cuff to support the joint capsule sufficiently without going under the knife. Again, that's a Julian question. As well as being an Osteo who specialises in climbing injuries, he's also an exercise scientist, and has seen a truckload of slap lesions in climbers of all grades.

In terms of the other person I mentioned, Wendy is in Melbourne, and you'll have to wait a few weeks to see her but she'll also be able to give good information re whether surgery is your only option and what you pre-hab / re-hab processes would be. She works closely with Greg Hoy and would be the person I'd be wanting you to hook with if you did decide to get Grey to operate.

Re Ultrasound - don't be too hard on the Horsham ultrasonographers - ultrasound won't pick up a slap lesion, you need an MRI for that, and you probably do have bicipital tendonosis. These conditions tend to cluster together such that when there's an RC tear and/or slap lesion, bicipital tendonosis is often an associated finding.

Re John Salmon, who did you speak to? Was it John himself, or someone in his office? He's a lovely man and he has a reputation for being very compassionate. It's not that irregular for people to get elective procedures done privately - ie without insurance. It's possible that the person you spoke to in his office was new and didn't understand that you wanted to pay up-front, ie not via Medicare. Some private health insurance companies are a real hassle to deal with in terms of administrative requirements and it doesn't make sense that he wouldn't operate privately, unless of course he's had issue with bad debts from previous private clients.

Hope that helps. If you need contact details for any of the people I've mentioned, EMAIL or CALL ME and I'll pass them along. Good luck with all and keep us posted on how you do.

Thanks Elaine, I did see Julian via Skype. You know how Julian is famous for never telling you to stop climbing? Like it's worth paying just to be told to keep climbing? Well, he told me to stop climbing. And he almost never suggests surgery. He reckons i need to go to surgery straight away. Aside from the massive tear, I have a cyst of goop compressing the nerves and wastage in my rotator cuff as a result.

I've got two appts in the next week - Richard Dallalana and Shane Barwood. Greg Hoy isn't avail til August and won't see me if I'm seeing someone else in his practice (ie Shane Barwood), but his receptionist assured me both of those surgeons are good and too wait until I've seen them.

I did ring John Salmon back to double check. His receptionist claims it's in case something goes wrong and you need to stay in hospital longer and costs blow out. She then suggested RD.

Going to Sydney would be kinda desperate. I'd be stuck miles from home with a disfunctional arm and follow up visits would continue to be difficult to fit in. I'll see how the Melbourne and Adelaide options pan out first.

Sorry - haven't logged in for a few days, only just read. Ok - sounds like you've got major issues. Sorry you didn't have any luck with Mr Salmon's rooms. He's one of the surgeons I suggest so good to know their policy on privately funded clients. Most of mine are insured but there's always the odd person who prefers to self-fund. How did you go with Wendy Braybon?

Let me know if you need another name. Would strongly suggest you get someone (shoulder physio) to look at you from the perspective of 'pre-hab' / supportive treatment to maximise the benefit that you'll get from surgery, assuming that is your only option, and to minimise the associated down time. Talk to RDs rooms and to SBs rooms and ask which physios they work with. If possible get specific names and not just the practice name.

Given the finding re muscle wastage, I really think you need to be dealing with that too, and sooner rather than later. Surgery will help with the structural damage, but it won't directly address the associated deconditioning arising from the neural involvement and related factors that's currently evident. Did Julian give you exercises etc to do in the meanwhile? Was there any talk of osteopathic treatment to address related factors (eg neural structures)? I'm not an osteo, so I can't say whether osteo could assist here but it might be worth exploring, if you haven't already done so.

There's something which has always bothered me about god and karma and their mates. Why are they so pathetically unimaginative?

Those nasty Egyptians hassling yo' homies? Maybe send a plague of native insects, which boom and bust in the surrounding arid landscape? Something which happens naturally every few years anyway, that'll really prove your existence........retard! You wanna properly fuk with 'em, omnipotent deity style? How about launching a plague of airbourne giant squid? That would have flipped the Pharaoh's cat-lovin' fuking mind!

I'll admit that turning Lot's wife into a pillar of salt was a pretty good niggling effort. I can almost hear the conversation.

Lot: "Ah, c'mon! Salt? Why would you do that?"

God: "IT IS NOT FOR YOU TO QUESTION MY JUDGMENT"

Lot: "No need to shout.....y'know, it'd make more sense if you'd turned her into a pillar of dogshit or something"

God: "DO NOT DEFY ME, LEST THOU BE TURNED TO A PILLAR OF CUMIN!"

Lot: "yeah great. What? is aldi having a fukin' special on condiments this week?"

Now some bitter hippy has started in with the karma nonsense. So Wendy has been bad and metaphorically torn out some bloke's heart? You know what? I'm pretty sure she's spent the last couple of weeks hanging out in a marine environment. If karma really were at play here, there's been plenty of opportunity for a giant squid to come and literally tear her heart out (yes, there is a theme here, I feel that giant squid are grossly under utilized as agents of divine vengeance).........but really, it wouldn't have to be a giant squid. If any marine invertebrate were to remove/squash/vaporise Wendy's heart, I'd admit that you have some sort of case for your whole karma hypothesis. But a shoulder injury? It's like you believe in the sort of karma that takes long lunches and knocks off early. Karma that puts in just enough that it isn't worth the trouble of firing them.

I hope this comes back to bite you, freesolo. Like maybe you'll get a parking ticket, or start some home renovation which'll end up taking much longer than expected. Then you'll know for sure that it was karma for this bullshit.

Hey StuE - my slap lesion is bigger than yours, nerneenerneener ... oh bugger, that's not really something to be excited about. I'm looking at 5 anchors. 6 weeks in sling. 6 months off climbing. 4 off swimming. 3 not even running. Exercise bike it is for me. That, or mouching around on the couch eating chocolate and feeling sorry for myself.

So Richard Dallalana turns out to seem really good. A surgeon with interpersonal skills even! Spent 45 minutes checking out my shoulder, the mri, explaining what's going on, answering questions. Discussed not doing anything vs doing the surgery. He's worked on climbers and circus performers a bit and seemed to understand how important it was I get back to good strength and range of movement. And he has a cancellation for 2 weeks time. So I'm tempted to just stick with him and get the bloody thing done.

Which leads me to my next question - private hospitals. I don't know anything about private hospitals! Anyone had surgery at Vimy House, Mercy Private or Carabini? It's normally done as an overnight stay, but is a bit cheaper if I have it done as day surgery. Would any who's had it done suggest day surgery would be ok?